How much do ACA premiums cost in Texas?
April 9, 2019 11:04 AM Subscribe
Someone we are close to will lose their COBRA health coverage as of the end of July. They can't find out how much an ACA insurance plan will cost without applying, but they can't apply until they are within 60 days of losing their coverage.
Difficulty: this is in Texas, whose stupidly cruel government refused to expand Medicare.
They talked to an ACA counselor at their clinic who assured them that, although their income is far too low to qualify for a subsidy, they can continue to be seen at the clinic for a very low sliding-scale payment. That's great, but what if a catastrophe occurs? What do people do then?
Depending on how much the premiums cost, maybe a family member could manage to pay for them. They need to be able to plan more than 60 days in advance, though! Can anyone give us a ballpark figure for what it costs?
A family member's surely going to have to pay for their expensive psychiatric medications, anyway. That looks like it'll run about $500 a month. No way can they do without the meds. Given the medication expense, maybe a gold or silver plan would end up being a better deal than a bronze plan. They are over the age of twenty-six so they can't be covered by their family's insurance.
Difficulty: this is in Texas, whose stupidly cruel government refused to expand Medicare.
They talked to an ACA counselor at their clinic who assured them that, although their income is far too low to qualify for a subsidy, they can continue to be seen at the clinic for a very low sliding-scale payment. That's great, but what if a catastrophe occurs? What do people do then?
Depending on how much the premiums cost, maybe a family member could manage to pay for them. They need to be able to plan more than 60 days in advance, though! Can anyone give us a ballpark figure for what it costs?
A family member's surely going to have to pay for their expensive psychiatric medications, anyway. That looks like it'll run about $500 a month. No way can they do without the meds. Given the medication expense, maybe a gold or silver plan would end up being a better deal than a bronze plan. They are over the age of twenty-six so they can't be covered by their family's insurance.
Kaiser Family Foundation has a calculator that may be a good starting point. The specifics matter a good bit in this case.
posted by matrixclown at 11:18 AM on April 9, 2019 [1 favorite]
posted by matrixclown at 11:18 AM on April 9, 2019 [1 favorite]
No experience in TX, but Oscar is usually in the ball park of typical for ACA coverage in NYS and CA. Here's a quote for one 30 year old non-smoker earning $50k. Hit "Edit Quote" to correct those assumptions.
posted by caek at 11:19 AM on April 9, 2019 [1 favorite]
posted by caek at 11:19 AM on April 9, 2019 [1 favorite]
Call them. 1-800-318-2596
Apply for Medicaid in Texas.
Low income does not preclude subsidy; but if they can get Medicaid, all the better.
The factors are age, location, maybe gender, and what's covered. It will vary wildly.
posted by theora55 at 11:22 AM on April 9, 2019 [1 favorite]
Apply for Medicaid in Texas.
Low income does not preclude subsidy; but if they can get Medicaid, all the better.
The factors are age, location, maybe gender, and what's covered. It will vary wildly.
posted by theora55 at 11:22 AM on April 9, 2019 [1 favorite]
Best answer: You can go directly to healthcare.gov/see-plans to get the exact costs of the plans, including costs for medications, copays, etc.
The clinic your family member went to, if they're a Federally Qualifed Health Center, may have a bulk medication rate that can be a lot cheaper than going through insurance, particularly if you end up getting a cheaper Bronze plan with high deductibles, just in case something catastrophic happens. Otherwise you are looking at a more expensive Silver or Bronze plan.
Texas did *not* expand Medicaid so unless your family member is legally disabled, they're unlikely to qualify. That means that yes, if their income is below 100% of the poverty line (about $1000 and change) they wouldn't be able to get the subsidies.
How are they supporting themselves right now? Is there any way to get their taxable income up past 100% of the poverty line, say through ongoing financial support from their family? That's going to drastically decrease the premiums, of course, and also it will mean much lower copays and deductibles, including much lower med costs, than if they're getting a full-price plan.
posted by tivalasvegas at 11:29 AM on April 9, 2019 [2 favorites]
The clinic your family member went to, if they're a Federally Qualifed Health Center, may have a bulk medication rate that can be a lot cheaper than going through insurance, particularly if you end up getting a cheaper Bronze plan with high deductibles, just in case something catastrophic happens. Otherwise you are looking at a more expensive Silver or Bronze plan.
Texas did *not* expand Medicaid so unless your family member is legally disabled, they're unlikely to qualify. That means that yes, if their income is below 100% of the poverty line (about $1000 and change) they wouldn't be able to get the subsidies.
How are they supporting themselves right now? Is there any way to get their taxable income up past 100% of the poverty line, say through ongoing financial support from their family? That's going to drastically decrease the premiums, of course, and also it will mean much lower copays and deductibles, including much lower med costs, than if they're getting a full-price plan.
posted by tivalasvegas at 11:29 AM on April 9, 2019 [2 favorites]
A relative in Austin is in a similar situation. I went with her to the offices of a non-profit there who were very helpful. Short version: single individuals need to earn $12k/year to qualify for subsidies, which brings the monthly cost of coverage down to less than $100/month (not sure about the quality of the coverage, but it’s Obamacare.) Below $12k they assume you’re on Medicaid. The organization is definitely worth contacting: Foundation Communities
posted by carterk at 11:30 AM on April 9, 2019 [3 favorites]
posted by carterk at 11:30 AM on April 9, 2019 [3 favorites]
They talked to an ACA counselor at their clinic who assured them that, although their income is far too low to qualify for a subsidy, they can continue to be seen at the clinic for a very low sliding-scale payment. That's great, but what if a catastrophe occurs? What do people do then?
Many hospitals have financial assistance programs, often they will write off 100% of the bill if someone's income is below 100% or 200% of the poverty line for the month(s) the service was rendered. I've helped people apply for those and the paperwork is not particularly onerous -- basically you just have to show proof of income. Hospital websites will have the financial assistance program info listed somewhere on their site (you may have to dig) or you can contact the hospital billing dept directly.
Specialists are more tricky -- does your family member see a psychiatrist or other specialists, or a therapist? The clinic may have some specialty care -- for instance, the FQHC I worked for had a psychiatric NP on staff who could assess more complicated psychiatric medication issues.
posted by tivalasvegas at 11:36 AM on April 9, 2019 [1 favorite]
Many hospitals have financial assistance programs, often they will write off 100% of the bill if someone's income is below 100% or 200% of the poverty line for the month(s) the service was rendered. I've helped people apply for those and the paperwork is not particularly onerous -- basically you just have to show proof of income. Hospital websites will have the financial assistance program info listed somewhere on their site (you may have to dig) or you can contact the hospital billing dept directly.
Specialists are more tricky -- does your family member see a psychiatrist or other specialists, or a therapist? The clinic may have some specialty care -- for instance, the FQHC I worked for had a psychiatric NP on staff who could assess more complicated psychiatric medication issues.
posted by tivalasvegas at 11:36 AM on April 9, 2019 [1 favorite]
Response by poster: Thank you all so much. Somehow we had not been not able to find the right page at healthcare.com on our own. The Kaiser calculator works well, too. Looks like even the highest-cost gold plan would be less per month than the best GoodRX.com prices on the necessary medications.
Is there any way to get their taxable income up past 100% of the poverty line, say through ongoing financial support from their family?
Is that even possible? I thought that gifts from family didn't add to taxable income.
posted by chromium at 11:51 AM on April 9, 2019
Is there any way to get their taxable income up past 100% of the poverty line, say through ongoing financial support from their family?
Is that even possible? I thought that gifts from family didn't add to taxable income.
posted by chromium at 11:51 AM on April 9, 2019
Shit, you're right. Sorry. There might be other things on that list that you could use to increase their income, though?
posted by tivalasvegas at 12:03 PM on April 9, 2019
posted by tivalasvegas at 12:03 PM on April 9, 2019
If family pays them for a service that would create taxable Schedule C income, then I think it would qualify. (No expertise, just brainstorming what to do for a likely future scenario in my own extended family.) The income would have to be reported for any other benefits that are income based and it would be taxable, although I don't know how much that would cost (federal, tax, social security, medicare taxes) also the person paying would have to file 1099 etc.
posted by metahawk at 12:43 PM on April 9, 2019
posted by metahawk at 12:43 PM on April 9, 2019
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posted by chromium at 11:06 AM on April 9, 2019